Factors associated with male involvement in postpartum reversible contraceptive use in Shebedino Woreda, Southern Ethiopia

Abstract

Background Men’s participation in long-acting reversible contraceptives during the postpartum period is a determinant of reproductive health outcomes and for achieving national and sustainable development goals. Most research findings on male participation in family planning are concerned with short-acting family planning in Africa, including Ethiopia. Despite this, little is known about male involvement in postpartum long-acting reversible contraceptive use of their wife in Africa, particularly in Ethiopia. Objective To assess the magnitude of male involvement in postpartum long-acting reversible contraceptive use and association factors among married males in Shebedinno woreda, Sidama regional state, Southern Ethiopia, 2023. Methods A community-based cross-sectional study was conducted among 633 randomly selected married men from July 30 to August 30, 2023. Data were collected using pretested, questionnaires. Bivariable and multivariable logistic regression analyses were conducted. Multicollinearity and model fitness were examined. The crude and adjusted odds ratios, together with their corresponding 95% confidence intervals, were computed. A P-value < 0.05 was considered a level of statistical significance. Result A total of 623 married men responded to the questionnaires, yielding a response rate of 98.4%. Out of these, 197 (31.6%, 95% CI: 28.6, 36.0) participants were involved in postpartum long-acting reversible contraceptive use. Men with a secondary school education (AOR = 2.35, 95% CI: 1.12, 4.93) and those with a diploma or higher education (AOR = 4.42, 95% CI: 1.80, 10.83), heard information about long-acting reversible contraceptives (AOR = 2.77, 95% CI: 1.07, 7.16), having good knowledge (AOR = 1.84, 95% CI: 1.24, 2.74) and a positive attitude towards the use of postpartum long-acting reversible contraceptives (AOR = 2.18, 95% CI: 1.47, 3.24) all proved to be positive significant factors. Conclusion and recommendations Overall, men’s participation in postpartum long-acting reversible contraceptive use of their spouse was relatively low. Therefore, promoting male participation in postpartum long-acting reversible contraceptives requires effective community awareness, dissemination of information, education, and communication, and fostering a positive attitude towards long-acting reversible contraceptives.

Introduction

Postpartum Long-Acting Reversible Contraceptives (LARC) utilization refers to the use of LARC within 12 months after childbirth¹. It offers benefits such as increased effectiveness, cost savings, and improved reproductive control for women^1,2. LARC is more effective than other contraception methods in preventing early unplanned pregnancies and reduce maternal health risks³. Despite their clinical benefits, the uptake of LARCs is still limited in many low- and middle-income nations due to sociocultural and gender-related issues⁴. In many communities, women’s reproductive choices are shaped by cultural norms, religious beliefs, and the dominant influence of male partners⁵. Additionally, myths about LARCs causing infertility or health problems further deter usage. These social factors limit women’s autonomy and contribute to the underutilization of safe contraceptive option⁶. Husbands play a crucial role in Family Planning (FP), leading women to avoid LARCs due to fears of marital conflict, accusations of infidelity, or societal fertility pressures^5,7. However, the adoption of postpartum FP in sub-Saharan Africa is inadequate, particularly in East Africa, where the utilization rate ranges from 10.3% in Ethiopia to 73.7% in Uganda⁸. Therefore, increase the adoption of LARC methods in the postpartum period, and reduce short birth intervals the involvement of males plays a crucial role, particularly in Sub-Saharan African countries like Ethiopia.

Male engagement in FP involves men actively participating in reproductive health, supporting their partners, and promoting gender equality⁹. Their engagement also enhances communication and promotes acceptance among partners, addressing unmet needs caused by the opposition of men. It also contributes to the success of FP programs and improves reproductive health outcomes^10,11. Male participation in FP, particularly the use of LARC, is an important technique to lower fertility and promote mother and child health¹².

Involving men in FP is one of the crucial public policy interventions to achieve national and Sustainable Development Goals (SDGs)¹⁰. Among the 17 SDGs, the direct health-related targets come under SDGs 3: Ensure healthy lives and promote well-being for all at all ages¹³. The SDGs contains reproductive, maternal, and child health as a priority agenda, which will not be attained without FP. To enhance the acceptance and uptake of FP among both sexes, male participation is important¹⁰. Therefore, achieving national and SDGs involving men in FP especially in postpartum LARC is very crucial.

In developing countries, the men are decision-makers including fertility. Even if the wife wants to use FP, she may not be able to use it or may be forced to discontinue the method without the involvement of men^14–16. This can hinder women from using FP methods, including LARC, during the postpartum period¹⁷. As such, men play a vital role in making decisions that are crucial for the welfare of maternal, newborn and child health¹⁸.

Despite the evidence indicating that close birth intervals are linked to unfavorable pregnancy outcomes, a significant number of women are not utilizing LARC in postpartum. This is due to the limited involvement of men in postpartum FP¹⁹. The involvement of men in postpartum FP is crucial for the uptake and continuation of contraceptives by women¹¹.

Male involvement in LARC during the postpartum period is crucial in developing countries like Ethiopia. Studies show that male participation varies greatly in Ethiopia, ranging from 8.4% in Debre Markos²⁰ to 70% in Gonder City²¹. However, current postpartum FP policies in Ethiopia primarily target women, disregarding the significant role of men in this process. Research on male involvement in FP, including thos conducted in Debre Tabor²², Gonder²¹ and Durame town, Ethiopia²³ has mainly been conducted in urban communities, with limited knowledge of rural communities.

Additionally, studies in Ethiopia have focused on male involvement in FP in general rather than specifically examining their involvement in postpartum LARC. There is limited knowledge regarding the extent to which men support their wives in utilizing LARC, particularly in the context of postpartum FP in Africa, including Ethiopia. Therefore, this study aimed to fill this gap in research by assessing the magnitude of male involvement in postpartum LARC use and identifying factors that influence male involvement in the Shebedino Woreda Sidama region state of southern Ethiopia.

Method and materials

Study area

Shebedino Woreda is found 27 km away from Hawassa, the capital city of Sidama Regional State, and 310 km from Addis Ababa, the capital city of Ethiopia. According to 2015 data obtained from the woreda administration, Shebedino Woreda has 23 rural and 3 urban kebeles. The total population of Shebedino Woreda is 204,618 and the sex ratio is 1:1. Among the total population 85% are living in rural areas. Total reproductive age groups are 56,288. The total households of in Shebedino Woreda is 41,759. The Woreda has one primary hospital, six health centers, and 23 health posts. The Woreda has one primary hospital, six health centers, and 23 health posts. This district was chosen due to limited research on contraceptive prevalence, ongoing maternal health initiatives, and a lack of studies on male involvement in postpartum LARC. Thus, investigating male participation in postpartum LARC is crucial.

Study design and period

A community-based cross-sectional study was conducted from July 30 to August 30, 2023.

Source of population

The source population of the study was all married men living in Shebedino woreda whose wives delivered in the past two years and using LARC.

Study population

All married men, whose wives were delivered in the past two years and using LARC living in selected kebeles from July 30 to August 30, 2023.

Eligibility criteria

Men who were living together with their wives; whose wives delivered in the past two years and using LARC; and men who lived with their wives for a minimum of six months at Shebedinno woreda were included in the study. Men who had mental illness, serious health problems and were unable to talk or hear were excluded from the study, and men who were not available at home during the data collection period after three visits were excluded.

Dependent variable

Male involvement in postpartum LARC utilization.

Independent variables

Socio-demographic and Socio-economic factors: Age of husband, age of wife, ethnicity, religion, husband’s education, education of wife, residence, husband’s occupation, occupation of wife, monthly income; Reproductive factor: Number of currently living children, time to have the next baby, how many children you want in the future, length of postpartum period. Knowledge of LARC method; Attitude of LARC method; Contraceptive related factors: Source of information, previous use of LARC by wife, emotional support, discussion between partners, financial support, accompanied wife to FP clinic, the benefit of using LARC method, type of LARC method known, ever use LARC method, decision making to use contraceptive, the reason for using LARC method from the current user.

Operational definitions

Attitude

Is measured by 9 items. Those who responded correctly above the mean value had a positive attitude and those whose scores were less than the mean value were categorized as having a negative attitude²⁴.

Knowledge

Is measured by 12 knowledge items assessing questions on postpartum LARC who responded correctly above the mean value were knowledgeable or had good knowledge while those who scored less than the mean value were considered as having poor knowledge²⁵.

Male involvement in postpartum LARC

Refers to the participation of men in postnatal LARC, encompassing activities such as discussion with their spouses, providing emotional support, and financial support, accompanying wives to the FP clinic, giving approval, engaging in decision-making at least greater than mean value.

Sample size determination

To determine the sample size, we used the formula for single population proportion using the following considerations: standard normal distribution corresponding to significance level at α = 0.05; 5% margin of error; the proportion of male involvement LARCM 50%. By adding 10% of the non-response rate and considering 1.5 design effect, the final sample size was 633.

Sampling techniques and procedure

Multistage sampling was employed in this study. A total of 26 kebeles were included, consisting of 3 urban and 23 rural areas. Through a lottery method, 10 kebeles (one urban and nine rural kebeles) were selected. The number of women who had given birth within the past two years was obtained from registration books of the health office, kebeles, and health extension workers. Additionally, the process involved identifying and retrieving the husbands of women from the member of the master of the family index and conducting home visits with the help of a health extension worker. The number of study units allocated to each selected kebele was determined using a probability proportional to size allocation. To achieve the required sample size of 633 study subjects, simple random sampling techniques were employed from the list obtained from the registration book. In cases where eligible participants were not found in the household, up to three attempts were made to revisit and interview them to minimize the non-response rate.

Data collection instrument

Questionnaire were adapted from different articles with some modifications from similar previous studies^11,12,26,27. Socio-demographic characteristics had 10 items, reproductive characteristics had 6 items, knowledge had 12 items, attitude 9 items, contraceptive related factor 8 items, and Male involvement in Postpartum LARC use measured by 6 items. The participant’s knowledge level was evaluated using twelve items, with “yes” or “no” response. Each “yes” response scored one point and each “no” response scored zero point, resulting in a possible range of scores from zero to twelve. Based on this total score, participants were classified into one of two categories; those with good knowledge (a score equal to or higher than the mean score) and those with poor knowledge(a score below the mean)²⁸. It should be noted that certain questions, specifically numbers three, six, eight, and nine, were subject to reverse coding. A Likert scale format consisting of nine questions with three answer alternatives, namely agree, indifferent, and disagree, was utilized to measure the attitude. The reverse code was applied to questions number three and five. The overall score was calculated, and individuals who scored equal to or above the mean score were deemed to have a positive attitude towards postpartum LARC. Conversely, those who scored below the mean score were categorized as having a negative attitude^11,24. The outcome variable was measured using six questions coded as Yes¹ and No (0) responses. Each “yes” response scored one point and each “no” response scored zero point, resulting in a possible range of scores from zero to six. Based on this total score, participants were classified into one of two categories; those with better involvement in FP (a score equal to or higher than the mean score) and those with low involvement or non-involvement(a score below the mean).

Data collection procedure

Data were collected by the Kobo toolbox through an interview and a structured questionnaire. The questionnaire was first created in English and then translated into the local language Sidamo Affo. The questionnaires were pretested by 5% (31 participants) of the total sample size before the actual data collection in Midregenet Kebele. Nine data collectors (7 BSc Midwifery and 2 supervisors) participated in the data collection. Data collectors were trained to be informed about how to approach the respondents, the objectives of the study and to keep the privacy of the respondents. During data collection, the supervisors checked for the completeness of the questionnaire.

Data processing & analysis

After the completion of data collection, a detailed examination was conducted on each questionnaire to ensure its completeness, consistency, and clarity. Subsequently, the collected data was exported to SPSS version 25 for further analysis. Descriptive statistics was summarized in frequency, graphs, and percentages. Assumptions such as the Chi-square test were first checked. Binary logistic regression was conducted and crude odds ratio, with a 95% confidence interval estimated to select the candidate variables for the final model. Then, a variable with a P-value of < 0.25 at binary logistic regression was taken into a multivariate logistic regression to control confounding. Hosmer-Lemeshow goodness-of-fit was used to test for model fitness. Variables with a P-value of < 0.05 were considered statistically significant predictors of the outcome variable.

Result

Socio-demographic characteristics of the study participants

A total sample size of 623 married men responded to the questionnaires, yielding a response rate of 98.4%. The mean age of men respondents was 35 with a standard deviation of ± 5.23 years and women’s age was 26with ± 4.88 years. The majority of the study participants 408(65.5%) adhere to the Protestant faith, and 518(83.1%) reside in rural areas. Of the respondents, 271 (43.5%) completed primary school education, and more than a third of the participants 226 (36.3) completed secondary school. Regarding occupation, half 316(50.7%) were farmers and more than one-quarter were 170(27.3%) merchants (Table 1).

Table 1.

Socio-demographic characteristics of the study participants in Shebedinno woreda, Sidama regional state, Southern Ethiopia, 2023 (n = 623).

Variables	Category	Frequency	Percentage
Age of husband	20–30	173	27.8
	31–40	318	51.0
	> 40	132	21.2
Age of wife	18–22	76	12.2
	23–27	159	25.5
	28–32	257	41.3
	33–37	131	21.0
Religion	Protestant	408	65.5
	Orthodox	116	18.6
	Muslim	94	15.1
	Catholic	5	0.8
Ethnicity	Sidama	524	84.1
	Amhara	45	7.2
	Wolaita	32	5.1
	Othersa	22	3.5
Residence	Rural	518	83.1
	Urban	105	16.9
Educational status of wife	Non-formal education	89	14.3
	Primary school	299	47.9
	Secondary school	201	32.3
	Diploma & above	34	5.5
Educational status of male	Non-formal education	76	12.2
	Primary school	269	43.2
	Secondary school	227	36.4
	Diploma &above	51	8.2
Occupations status of wife	Farmer	330	52.9
	Housewife	135	21.7
	Merchant	96	15.4
	Daily laborer	41	6.6
	Employer	21	3.4
Occupational status of husband	Daily laborer	58	9.3
	Employer	79	12.7
	Merchant	170	27.3
	Farmer	316	50.7
Average monthly income(birr)	< 1199	186	29.9
	1200–2499	199	31.9
	> 2500	238	38.2

^aOromo, Silte, Gurage

Reproductive characteristics of the study participants

The mean number of children currently residing with each male was 3. Of the participants, 524 (84.1%) expressed their desire to have more children. Of this group, more than half of 303(57.8%) indicated a preference for having less than three children in the future. Regarding the sex of their future children, approximately 271(51.7%) of the study participants expressed a preference for a male child. Out of the total participants, 379(60.8%) reported having at least one male child. More than half 300(57.3%) of participants, indicated a desire to have their next child within a two to three-year timeframe (Table 2).

Table 2.

Reproductive characteristics of the study participants in Shebedino Woreda, Sidama Region, Southern Ethiopia, 2023 (n = 623).

Variable	Category	Frequency	Percent
Number of currently living Children	≤ 2	231	37.1
	2-3	287	46.1`
	>4	105	16.9
Wanting more children	No	99	15.9
	Yes	524	84.1
Desired Noof children	≤ 2	303	57.8
	≥3	221	42.2
Sex of the future desired child	Both equal	111	21.2
	Female	66	12.5
	Male	271	51.7
	No preference	76	14.5
Birth space	<2 year	63	12.0
	2-3 year	300	57.3
	>3 year	161	30.7
The postpartum period in the month	0-6	197	31.6
	7-12	305	49.0
	13-24	121	19.4

Contraceptive-related characteristics of the study participants

Out of the study participants, 558 (89.6%) heard about LARC methods. The majority of the study participants (86.0%) received information from healthcare institutions, while 68.1% obtained it from media sources. The most known LARC method was the implant, with 539 (96.6%) respondents being aware of it, while 447(80.1%) were familiar with IUCD. The participants were queried regarding the type of LARCM currently employed, with 588 (94.4%) indicating implant usage. Regarding the decision about the current use of LARCMs, 312 (50.1%) of the respondents made the decision together, while 159 (25.5%) of the study participants decided by their wives (Table 3).

Table 3.

Contraceptive-related characteristics of the study participants in Shebedinno woreda, Sidama region, Southern Ethiopia, 2023 (n = 623).

Variable	Categories	Frequency	Percent
Information heard about LARCM	No	65	10.4
	Yes	558	89.6
Type of LARCMs know	Implant	539	96.6
	IUCD	447	80,1
Types of LARCM that are currently used	Implant	588	94.4
	IUCD	35	5.6
Reason for using LARC method from the current user	Birth limiting	99	15.9
	Birth spacing	524	84.1
Ever used LARC methods in the past	No	360	57.8
	Yes	263	42.2
Decision the current LARC use	Both of us	312	50.1
	Myself	67	10.8
	wife	159	25.5
	Health care providers	63	10.1
	Othersa	22	3.5
Number of discussions with their partner about LARCM in the past 2 years	More than twice	93	27.4
	Twice	122	35.9
	Once	125	36.7
The benefit of using LARCMs	Prevent unwanted pregnancy	438	70.3
	For spacing	440	70.6
	For limiting	386	61.9
	Reduce maternal and child death	221	35.5

Knowledge-related characteristics of study participants

The majority of respondents knew about the insertion of IUCD in the uterus (80.75%) and implant in the upper arm(89.1%) by a skilled healthcare provider. More than a third 422 (67.7%) of respondents were aware that IUCDs provide effective protection against unwanted pregnancy and used for over a decade. In general, more than half (53.1%) of respondents had poor knowledge about LARC (Table 4).

Table 4.

Knowledge-related characteristics of the study participants in Shebedinno woreda, Sidama regional state, South Ethiopia, 2023 (n = 623).

Knowledge of LARCM items	Yes (%)	No (%)
IUCDa is inserted into the uterus by a skilled healthcare provider.	503(80.75)	120 (19.3%)
implant inserted in the upper arm by the skilled healthcare provider.	555(89.1%)	68 (10.9%)
IUCD causes cancer	301(48.3%)	322(51.7%)
IUCDs are immediately reversible	462(74.2%)	161(25.8%)
Implants effectively protect from unwanted pregnancies for 3–5 years	560(89.9)	63(10.1%)
Implants prevent STI	213(34.2%)	410(65.8%)
IUCD prevents pregnancy for more than 10 years	422(67.7%)	201(32.3%)
IUCD is appropriate for STI high-risk women	252(40.4%)	371(59.6%)
IUCD interferes with sexual desire	268(43.0%)	355(57.0%)
IUCD effectively protects from unwanted pregnancy	358(57.5%)	265(42.5%)
the implant is immediately reversible	456(73.2%)	167(26.8%)
Implants require a minor surgical procedure	251(40.3%)	372(59.7%)

^aIUCD Intra-uterine contraceptive devices

Attitude-related characteristics of the study participants

This study assessed respondents’ attitudes toward postpartum LARC. Overall, the positive attitude towards postpartum LARC was 55.5%. The majority of study participants 541 (86.8%) agreed that men should share responsibility for using LARC methods. More than half of the study participants 358 (57.5%) believed that the use of intrauterine contraceptives (IUCDs) does not interfere with routine activities. However, more than a quarter of participants (28.7%) believed that using IUCDs and implants in future pregnancies could lead to infertility (Table 5).

Table 5.

Attitude-related characteristics of the study participants in Shebedinno woreda, Sidama region, South Ethiopia, 2023 (n = 623).

Attitude items towards LARCM	Agree (%)	Disagree(%)	Neutral (%)
LARC information service should be available to men	492(79.0%)	80(12.8%)	51(8.2%)
Using IUCD does not restrict routine activity	358(57.5%)	104(16.7%)	161(25.8%)
Insertion and removal of Implant is highly painful	209(33.5%)	338(54.3%)	76(12.2%)
Implants don’t move through the body after insertion	494(79.3%)	62(10.0%)	67(10.8%)
Using IUCD and implants causes infertility	179(28.7%)	373(59.9%)	71(11.4%)
Men should share the responsibility for using LARC method.	541(86.8%)	62(10.0%)	20(3.2%)
Long-acting contraceptives should not be used only by women who do not want more children.	348(55.9%)	261(41.9%)	14(2.2%)
Discussion about LARC method with the wife is necessary	497(79.8%)	80(12.8%)	51(8.2%)
IUCD doesn’t move through the body after insertion	340(54.6%)	111(17.8%)	172(27.6%)

Male involvement in postpartum LARC use

Of the 623 married male participants, 197 (31.6%, 95% CI: 28.6, 36.0) were involved in postpartum LARC method use by their spouse. More than half of the participants 340 (54.6%) reported having engaged in discussions with their wives. Nearly a quarter of 151 (24.2%) reported accompanying their wives to health facilities for family planning-related services (Table 6).

Table 6.

Male involvement in postpartum long-acting reversible contraceptive use in Shebedino, Sidama region, Southern Ethiopia 2023.

Variable	Categories	Frequency	Percentage
Discusses FP with their partner	No	283	45.4
	Yes	340	54.6
Provides financial support	No	192	30.8
	Yes	431	69.2
Provide emotional support	No	244	39.2
	Yes	379	60.8
Accompany wife to the health facility for FP	No	484	57.8
	Yes	139	24.2
Decision on the current LARC usea	No	247	39.6
	Yes	376	60.4
Approve the choice of wife	No	129	22.0
	Yes	494	78.0

^ano =wife and other; Yes = myself and both

Factors associated with men’s involvement in postpartum LARC

The goodness of fit using the Hosmer & Limenshaw test was a P-value = 0.221. Additionally, pseudo-R-square regression results show that the square of the correlation between its predictor value and the actual value of the outcome of this correlation was 33.8%. the model explains 33.8%(Negelkerke R square)of variance in the male partner involvement in postpartum LARC. The variables that demonstrated significant association with men’s involvement in postpartum LARC utilization at their P-value ≤ 0.05 include educational status, information heard about LARC, knowledge of postpartum LARC, and attitude toward postpartum LARC (Table 7).

Table 7.

Factors associated with men’s involvement in postpartum LARC in Shebedinno Woreda, Sidama regional state, South Ethiopia, 2023 (n = 623).

Variable	Male Involvement		COR(95%CI)	AOR(95%CI)
	Involve	not involve
Age of husbands
20–30	71	102	2.98 (1.753,5.064)	1.30(0.657–2.59)
31–40	101	217	1.99 (1.214,3.269)a	1.12(0.608–2.08)
> 40	25	107	1	1
Residence
Rural	151	367	1	1
Urban	46	59	1.89(1.233, 2.912)a	1.39(0.86–2.25)
Occupation of husband
Farmer	75	241	1	1
Daily labors	22	36	1.96(1.088–3.54)a	1.179(0.61–2.25)
Merchant	61	109	1.79(1.19–2.70)a	1.22 (0.77–1.91)
Employer	39	40	3.13(1.88–5.23)a	1.72(0.96–3.08)
Educational of husband
No formal education	13	63	1	1
Primary school	65	204	1.54(0.8–2.99)	1.19 (0.57–2.50)
Secondary school	90	137	3.18(1.656–6.12)a	2.35(1.12–4.93) b
Diploma and above	29	22	6.39(2.83–14.43)a	4.42(1.803–10.83.803.83 c
No currently living children
≤ 2	99	132	1	1
3–4	77	210	0.49(0.338,0.707)a	0.64(0.39–1.01)
> 4	21	84	0.33(0.193,0.575)a	0.69(0.32–1.46)
Information heard about LARC
No	7	58	1	1
Yes	190	368	4.28(1.92–9.55)a	2.77(1.07–7.16) b
Wanting more children
No	17	82	1	1
Yes	180	344	2.53(1.452,4.386)a	0.97(0.44–2.14)
Knowledge of LARC
Poor	71	260	1	1
Good	126	166	2.78(1.959–3.94)a	1.84(1.24–2.74) c
Attitude of LARC
Unfavorable attitude	59	218	1	1
Favorable attitude	138	208	2.45(1.855,3.798)a	2.18(1.47–3.24) c

^aP<0.25 for bivariate analysis; ^bP<0.05, ^cP<0.01 for multivariate analysis

Discussion

In the this study out of the total of 623 male study participants 197 (31.6%, 95% CI: 28.6, 36.0) were engaging in their wife’s or spouse’s use of postpartum LARC. This finding corresponds with previous investigations conducted in the Mizan-Aman district of Southwestern Ethiopia (32.8%) as reported by Mulatu and Mekonnen²⁵ and the Malegedo town within the West Shoa zone (36.0%)²⁸. These findings suggest that this similarity in LARC involvement could potentially be attributed to comparable educational attainment levels among these populations.

The prevalence rate in the present study was higher than the rates reported in Bahir Dar town (25.5%)²⁹, Angolela Tera district in the Amhara region (26.7%)²⁶ West Badewacho district (19.9%)¹² and Debre Markos town (8.4%)²⁰. This discrepancy in findings may stem from temporal differences between data collection periods and sociocultural variations prevalent in the studied community. Additionally, it may be influenced by improvements in healthcare facilities, increased shared responsibility, higher educational attainment, and the community’s attitude towards male involvement in FP services³⁰. Furthermore, the observed higher prevalence rate of male involvement in this study compared to the rates reported in Loka Abaya district (16.6%)²⁶ and Debre Markos town (8.4%)²⁰ could potentially be attributed to the limited sample size and sampling period, as well as sociocultural differences. Moreover, it is important to note that this study considered males as supportive partners, whereas other studies might have measured male involvement differently. The discrepancy in findings with the West Badewacho district¹² could be due to differences in data collection time, sample sizes, and the inclusion of men’s participation in long-acting and permanent contraceptives. This study specifically focused on men’s participation in LARC, which may have contributed to the higher prevalence rate since LARC methods, such as implants, are more well-known (87%) compared to less known methods like laparoscopic permanent methods (13%) as reported in the Ethiopian Demographic and Health Survey³¹.

The finding of this study (31.6%) was lower than the study conducted in Nigeria³², Durame town²³, East Hararghe¹⁰, and Debre Tabor town²². The variations in prevalence rates between the current study and those conducted in Nigeria (55.1%)³² and East Hararghe (59.3%)¹⁰ may be attributed to demographic and socio-cultural differences among the study subjects, as well as differences in study settings and sample sizes. Furthermore, the measurement of male involvement in East Hararghe included decision-making and support, whereas the current study employed six components, contributing to the observed discrepancy in findings.

The prevalence rate of male involvement in the current study was also lower compared to the findings from Durame town (69.7%)²³ and Debre Tabor town (68.1%)²². This difference may be attributed to variations in sample size and study setting, as both previous studies primarily focused on urban residents, whereas the current study included both rural and urban participants. It is possible that residing in urban areas, engaging in discussions with wives, possessing extensive knowledge, and exhibiting a positive attitude toward FP usage influenced the prevalence of male involvement³³. Additionally, the variation in the measurement of male involvement should be noted, as the previous studies employed two frameworks, namely user and supportive partner, while the current study solely focused on measuring the supportive partner’s involvement. Moreover, it should be acknowledged that previous studies have examined male involvement in all FP methods, whereas the current study specifically concentrated on postpartum LARC methods. This narrower focus may potentially underestimate the true extent of male involvement in FP.

This study elucidated that variables such as the possession of comprehensive knowledge concerning LARC, the educational attainment of the husband, previous exposure to information about LARCs, and harboring a favorable disposition towards the utilization of LARCs, played significant roles in influencing male involvement about their partner’s adoption and employment of LARCs.

Our findings suggest that the educational level of men was associated with their partners’ use of postpartum LARC. The results indicate that men who had completed secondary school or possessed a diploma were approximately twice and four times more likely engage their partners’ use of postpartum LARC respectively, compared to those with no formal education. Notably, these findings align with prior investigations conducted in Bahir Dar²⁹, the Womberma district in northern Ethiopia¹¹. A plausible explanation for this trend could be that educated men possess a more comprehensive understanding of FP and its significance, thereby motivating their active involvement in FP practices.

Knowledge about LARC emerged as the second significant predictor of male engagement. It was observed that individuals possessing good knowledge of postpartum LARC were nearly twice as likely to engage in postpartum LARC utilization in comparison to those with poor knowledge. Such findings align with a previous investigation conducted in the Womberma district of northern Ethiopia¹¹. Notably, the finding was higher than that reported in the Afar study, possibly due to sociocultural disparities and differing study settings. Conversely, the finding was lower than that observed in studies conducted in West Bedawacho¹², Debre Tabor town²² and Durame town²³. This divergence may be attributed to sociocultural and study setting variances. The discrepancy in levels of male involvement can be explained by the inclination of men with adequate knowledge of contraceptive methods to actively participate in selecting suitable methods for their partners. Moreover, well-informed men on postpartum FP, particularly LARC options, may directly engage in decision-making processes surrounding FP and encourage their partners to do the same¹².

Male exposure to information about the LARC method was found to be a predicting factor of their involvement in their spouse’s postpartum LARC use. The findings reveal that men who had received information about the LARC method were nearly three times more likely to be involved in postpartum LARC compared to those who had not received such information. This result aligns with a previous study conducted in Malegedo Town, West Shoa Zone²⁸, although the finding is higher in comparison to a study conducted in Debre Tabor Town²². The disparity in findings could be attributed to differences in the sources of information utilized in the two studies. In the Debre Tabor Town study, parents and newspapers were identified as the primary sources of information, while in the present study, participants reported obtaining information from healthcare institutions. Consequently, information obtained from healthcare institutions tends to be more comprehensive, accurate, and trustworthy, thereby potentially enhancing attitudes, dispelling misconceptions, and promoting behavioral changes to facilitate male involvement³².

Finally, having a positive attitude towards FP was identified as a crucial determinant for male engagement in FP services. Men who showed a positive attitude towards postpartum LARC were found to be two times more likely to participate in such services, in comparison to those who held a negative attitude towards postpartum LARC. This finding aligns with research conducted in West Bedawacho¹² and Womberma District in Northern Ethiopia¹¹. This finding might be due to the study setting, and sample sizes. This suggests that men’s favorable attitude towards postpartum LARC endorses and encourages their wives to utilize them. Additionally, men who show a positive outlook towards postpartum LARC may exhibit interest in participating in their partners’ FP services.

Strengths and limitations

• The direct interviewing of men was the strength of this approach, as it provided them with enhanced opportunities to confidently express their opinions, ideas, and perspectives.

• By maintaining a warm relationship and building rapport, we aimed to mitigate biases.

• Men were interviewed in the presence of their female partners, encourages future couple communication, mutual decision-making, builds trust and greater male involvement in supporting equitable and informed contraceptive choices.

• The quantitative survey fails to address the underlying reasons for the lack of male involvement in postpartum LARC.

• Recall bias could be introduced when men describe events or conversations in the past.

Conclusion

Our study revealed that male involvement in their partners’ LARC use was relatively low. The regression analysis indicated that male involvement was significantly associated to higher education beyond the primary level, having good knowledge of LARC, information heard about LARC, and having a positive attitude towards LARC. The findings of this study suggest strategies to increase male participation in postpartum LARC use, including enhancing community awareness, promoting education, fostering a positive attitude towards LARC, and suggesting further qualitative studies to address socio-cultural gender norms.

Author contributions

Abdulah Wassu Muhe designed the study, methodology, prepared the proposal, obtained the data, analyzed and interpreted the data, software, supervision, project administration, writing original draft. Gedion Asnake Azeze and Andargachew Kassa involved in methodology and formal analysis, software, supervision reviewed and commented the entire of the paper from inception to end for its intellectual content. Abdulah Wassu Muhe and Gedion Asnake Azeze prepared the first draft of this manuscript. All authors reviewed, revised and approved the manuscript for publication.

Data availability

All data relevant to the study are in the article.

Declarations

Competing interests

The authors declare no competing interests.

Ethical approval

The current study is conducted in accordance with the Declaration of Helsinki. Ethical clearance was obtained from the Institutional Review Board (IRB) of Hawassa University, College of Medicine and Health Sciences((Reference number: HUCMH/IRB/351/15) on date of 29/06/2023. The official letter of support was provided by the Hawassa town health office to the Shebedino City health department, whereas the Shebedino City health department issued a supporting letter that was later handed over to the selected kebele. Before the commencement of the study, all participants were informed of its objectives, and consent was obtained from both spouses (husband and wife). Confidentiality was ensured for the information by not recording the name of the respondent or other identifiers. Participant’s privacy, confidentiality, and cultural norms were respected properly.

Patient consent for publication

Consent taken directly from patient(s).